Early quality of life in patients with localized prostate carcinoma: an examination of treatment-related, demographic, and psychosocial factors.

BACKGROUND: Men with localized prostate carcinoma are faced with important treatment decisions, and quality of life (QoL) information has become a crucial element of decision making. The first objective of this study was to compare the early, health-related QoL (HRQoL) of men with localized prostate carcinoma who were treated with radical prostatectomy, external beam radiotherapy, or brachytherapy. A second objective was to identify demographic and psychosocial variables that predict HRQoL. METHODS: Two-hundred fifty-six men with localized prostate carcinoma were interviewed within 7 weeks of treatment initiation. The interview included measures of prostate-specific HRQoL (the University of California-Los Angeles Prostate Cancer Index), general HRQoL (the SF-36), and psychosocial variables. RESULTS: After adjusting for covariates, treatment group differences were found for both prostate specific HRQoL and general HRQoL. Men who underwent prostatectomy reported more urinary and sexual problems and more general physical dysfunction compared with men who were treated with either form of radiation therapy. Men who were treated with brachytherapy reported the fewest problems in sexual function and the least general physical dysfunction. Few treatment group differences were found in mental functioning. Both demographic factors and psychosocial factors predicted HRQoL. Older men and African-American men reported more physical problems than younger men and Caucasian men, respectively. A supportive social environment, high self-efficacy, and high self-esteem were predictive of better HRQoL. CONCLUSIONS: Shortly after undergoing treatment for localized prostate carcinoma, men who underwent radical prostatectomy, older men, and African-American men are at heightened risk for experiencing prostate-specific and general deficits in HRQoL. Having psychosocial resources from which to draw may enhance HRQoL.

Cross-cultural differences in tolerance for crowding: fact or fiction?

It is widely believed that cultures vary in their tolerance for crowding. There is, however, little evidence to substantiate this belief, coupled with serious shortcomings in the extant literature. Tolerance for crowding has been confused with cultural differences in personal space preferences along with perceived crowding. Furthermore, the few studies that have examined cultural variability in reactions to crowding have compared subgroup correlations, which is not equivalent to a statistical interaction. Although the authors found a statistical interaction indicating that Asian Americans and Latin Americans differ in the way they perceive crowding in comparison to their fellow Anglo-American and African American citizens, all four ethnic groups suffer similar, negative psychological distress sequelae of high-density housing. These results hold independently of household income.

Talking facilitates cognitive-emotional processes of adaptation to an acute stressor.

The authors examined the influence of talking and the social context of talking on cognitive-emotional processes of adjustment to stressors. Two hundred fifty-six undergraduates viewed a stressful stimulus and were then assigned to a no-talk control condition or 1 of 3 talk conditions: talk alone, talk to a validating confederate, or talk to an invalidating confederate. Two days later, they were reexposed to the stressor. Compared with individuals in the no-talk condition, those in the talk alone and validate conditions had a lower level of intrusive thoughts in the 2-day interim, and they had lower perceived stress when reexposed to the stressor. The effects of talking and validation on perceived stress appeared to be mediated by lowered intrusions. The benefits of talking were diluted when disclosures were invalidated. These findings suggest that talking about acute stressors can facilitate adjustment to stressors through cognitive resolution.

Nonevaluative social support reduces cardiovascular reactivity in young women during acutely stressful performance situations.

We tested whether the presence of a stranger reduces cardiovascular responses during stressful tasks if the evaluation potential of the stranger is minimized and whether cardiovascular responses are affected by the quality of support in a friendship. Undergraduate women performed stressful tasks in one of three conditions: Alone, with a same-sex Stranger, or with a same-sex best Friend. The stranger and friend could not hear participants' responses. Alone women had the greatest increases in SBP and HR while women in the Stranger and Friend conditions did not differ in their responses. In the Friend condition, HR responses were smallest in women who were highly satisfied with the support that they generally received from their friend. We conclude that the presence of a nonevaluative friend or stranger can reduce cardiovascular responses and that the quality of supportive ties modulates the impact of those ties on responses to stress.

Negative emotions and acute physiological responses to stress.

One pathway through which stressors are thought to influence physiology is through their effects on emotion. We used meta-analytic statistical techniques with data from nine studies to test the effects of acute laboratory stressors (speech, star mirror-image tracing, handgrip) on emotional (undifferentiated negative emotion, anger, anxiety) and cardiovascular (CV) response. In all of the studies, participants responded to stressors with both increased CV response and increased negative emotion. Increases in negative emotion were associated with increases in CV response across tasks, however, these associations were small. The range of variance accounted for was between 2% and 12%. Thus, the contribution of negative emotion, as assessed in these studies, to physiological responses to acute laboratory stressors was limited. Although these results raise questions about the role of emotion in mediating stress-elicited physiological responses, the nature of the acute laboratory stress paradigm may contribute to the lack of a strong association.

The role of social and cognitive processes in children's adjustment to community violence.

This study examined associations of community violence exposure and psychological well-being among 99 8-12 year old children (M = 10.7 years) using home interviews with mothers and children. Both moderators and mediators of the links between violence exposure and well-being were tested. After demographics and concurrent life stressors were controlled for violence exposure was significantly associated with intrusive thinking, anxiety, and depression. Regression analyses indicated that intrusive thinking partially mediated associated between violence exposure and internalizing symptoms. Planned comparisons revealed that violence exposure had the strongest effect on well-being among children with low social support or high levels of social strains. Furthermore, children with high levels of intrusive thinking were most likely to show heightened internalizing symptoms when they had inadequate social support.

Problems and prospects for the social support-reactivity hypothesis.

Social support and integration have been linked to health and longevity in many correlational studies. To explain how social relationships might enhance health, investigators are examining the effects of social support on physiological processes implicated in disease. Much of this research focuses on testing the social support-reactivity hypothesis, which maintains that social support enhances health by reducing psychobiologic reactivity to stressors. This article identifies the basic assumptions, problems, and prospects of this research endeavor. The major problems discussed include: (a) inconsistent findings across studies; (b) unidentified cognitive and emotional mediators; (c) individual differences in response to social support; and (d) a lack of experimental studies on the role of social support in adjustment to chronic stress. Besides raising consciousness about these problems, I offer ideas for advancing research in this area.

Chronic residential crowding and children's well-being: an ecological perspective.

Chronic residential crowding is associated with difficulties in behavioral adjustment at school, poor academic achievement, heightened vulnerability to the induction of learned helplessness, elevated blood pressure, and impaired parent-child interpersonal relationships among a sample of working-class, 10-to 12-year-old children living in urban India. The significant main effects of residential crowding on blood pressure and learned helplessness are moderated by gender. Residential crowding is positively associated with blood pressure only among boys and with helplessness only among girls. All analyses statistically control for household income. We then demonstrate that perceived parent-child conflict functions as an underlying, intervening process that largely accounts for several correlates of household crowding among children.

Expressive writing moderates the relation between intrusive thoughts and depressive symptoms.

The author investigated whether expressive writing enhances emotional adaptation to a stressful event (graduate entrance exams) by reducing event-related intrusive thoughts or by desensitizing people to such thoughts. Participants in the experimental group, who were instructed to write their deepest thoughts and feelings about the exam, exhibited a significant decline in depressive symptoms from 1 month (Time 1) to 3 days (Time 2) before the exam. Participants in the control group, who wrote about a trivial topic, maintained a relatively high level of depressive symptoms over this same period. Expressive writing did not affect the frequency of intrusive thoughts, but it moderated the impact of intrusive thoughts on depressive symptoms. Specifically, intrusive thoughts at Time 1 were positively related to depressive symptoms at Time 2 in the control group and were unrelated to symptoms in the expressive writing group.

Relation of chronic and episodic stressors to psychological distress, reactivity, and health.

This study tested the hypothesis that exposure to chronic stressors, which reflect persistent, negative life situations, would have greater physiological, psychological, and physical health costs than exposure to episodic or intermediate-length stressors, which reflect relatively transient, negative life situations. We also tested whether cardiovascular reactivity, conceptualized as a marker of underlying pathophysiological states, would mediate the relation between chronic stress and psychological distress and illness. Participants were 75 male and 75 female college students. Compared with students experiencing few chronic life stressors, students experiencing many chronic life stressors had exaggerated cardiovascular responses to acute challenges, delayed recovery to resting levels of cardiovascular functioning after the acute challenges, elevated psychological distress levels, and they reported more illnesses. None of the outcomes was associated with the number of episodic or intermediate-length life stressors students experienced. Cardiovascular reactivity did not mediate the stress-distress or stress-illness associations. The results suggest that ongoing stressors that are static are more detrimental to health and well-being than are episodic of change-related stressors.

Social constraints, intrusive thoughts, and depressive symptoms among bereaved mothers.

The study examined how social constraints on discussion of a traumatic experience can interfere with cognitive processing of and recovery from loss. Bereaved mothers were interviewed at 3 weeks (T1), 3 months (T2), and 18 months (T3) after their infants' death. Intrusive thoughts at T1, conceptualized as a marker of cognitive processing, were negatively associated with talking about infant's death at T2 and T3 among socially constrained mothers. The reverse associations were found among unconstrained mothers. Controlling for initial level of distress, there was a positive relation between T1 intrusive thoughts and depressive symptoms over time among socially constrained mothers. However, higher levels of T1 intrusive thoughts were associated with a decrease in T3 depressive symptoms among mothers with unconstrained social relationships.

Cynicism, social support, and cardiovascular reactivity.

This study examined whether highly cynical individuals benefit less from social support during an acute stressor than individuals low in cynicism. College students (52 men, 52 women) performed a stressful speech task alone or in the presence of a supportive confederate. There was an interactive effect of social support and cynicism on cardiovascular reactivity: Low cynicism participants who received support has smaller increases in blood pressure during the speech than low cynicism participants without support and high cynicism participants with or without support. Participants' psychological stress appeared to mediate the main effects of support on blood pressure reactivity, but not the Support x Cynicism interaction. Results suggest that cynical attitudes may undermine the stress buffering potential of interpersonal support.

Distorting children's reports and interpretations of events through suggestion.

Fifty-four children (33 girls and 21 boys), 4 to 6 years old, participated in an experiment examining the effects of leading interviews on their interpretations and factual recall of an interaction with a teaching assistant (TA). Children were either familiar or unfamiliar with the TA and were interviewed in either an incriminating or a neutral manner. In comparison with neutral-interview children, incriminating-interview children made more cued-recall errors and endorsed more biased interpretations of the TA's actions. Familiarity with the TA had limited effects on free recall and interpretations of the TA's actions and had no effect on cued recall. Results indicated that 4- to 6-year-olds will produce misleading reports about their interactions with either familiar or unfamiliar adults when they are prompted to do by an opinionated adult interviewer.

Social support lowers cardiovascular reactivity to an acute stressor.

This study examined whether social support can reduce cardiovascular reactivity to an acute stressor. College students gave a speech in one of three social conditions: alone, in the presence of a supportive confederate, or in the presence of a nonsupportive confederate. Systolic and diastolic blood pressure were measured at rest, before the speech, and during the speech. While anticipating and delivering their speech, supported and alone subjects exhibited significantly smaller increases in systolic and diastolic blood pressures than did nonsupported subjects. Supported subjects also exhibited significantly smaller increases in systolic blood pressure than did alone subjects before and during the speech. Men had higher stress-related increases in blood pressures than did women; but gender did not moderate the effects of social support on cardiovascular reactivity. These results provide experimental evidence of potential health benefits of social support during acute stressors.

Household crowding and social support: a quasiexperimental analysis.

People often cope with crowded living conditions by socially withdrawing from their housemates. This coping strategy may overgeneralize, influencing social interactions with others outside the home. In a stressful laboratory situation, Ss from crowded homes, in comparison with uncrowded counterparts, are less likely to seek support from a confederate and rate the confederate as less supportive. Moreover, Ss from crowded homes are less likely to offer support to a confederate in need. These differences in social interaction behaviors appear to be attributable to crowded residents' social withdrawal.

Social conflict, social support, and psychological distress: evidence of cross-domain buffering effects.

A longitudinal study examined the relative and joint effects of perceived social support and social conflict on psychological distress in 228 college students. Women had higher perceived social support from roommates and friends and less conflict with roommates than did men; there were no gender differences in level of conflict with friends or psychological distress. Roommate conflict predicted increases in psychological distress over time; this effect was attenuated by high levels of perceived social support from friends. Friend conflict also predicted increases in psychological distress over time; this effect was attenuated by high levels of perceived social support from roommates. These results show the importance of negative and positive aspects of social experiences to emotional functioning and the importance of compensatory social support for individuals facing social conflicts.

Dynamic role of social support in the link between chronic stress and psychological distress.

How a chronic environmental stressor can interfere with the buffering effects of social support by eroding social support was analyzed in this prospective, longitudinal study. A classic buffering effect of support was found after 2 months of exposure to the stressor, household crowding. Crowded residents with low perceived support had greater increases in psychological distress than did crowded residents with high perceived support. However, after 8 months exposure the buffering effect disappeared. Moreover, greater crowding had become directly associated with lower support, which in turn was associated with greater increases in psychological distress. All analyses controlled for prior distress. Under some types of chronic stress, the buffering effects of social support may be short-lived because the stressor eventually erodes social support.

Social hassles and psychological health in the context of chronic crowding.

Data are presented on the interactive effects of an enduring environmental stressor with acute, daily social stressors on psychological distress. A cross-sectional study of males in urban India and a longitudinal study of male and female American college students examined the interplay of these two types of stressors. In India, social hassles in the home predicted psychological symptoms only among residents of crowded homes, after statistically adjusting for income. In America, the interaction between social hassles and crowding was replicated in analyses adjusting for prior psychological symptoms, prior social acquaintanceship with housemates, and income. A six-month follow-up study with the American sample replicated the interaction. In all three analyses of the social hassle-crowding interaction, there was a main effect of crowding but no main effect of social hassles on psychological symptoms. These findings suggest that some chronic environmental stressors may increase the impact of acute social stressors, and highlight the importance of examining contextual factors in the stress and health process.

Daily hassles and chronic strains: a hierarchy of stressors?

Among 105 poor, male heads of household in an urban center of India, common daily hassles were similar to those experienced by individuals from economically advantaged, western countries. However, we did not replicate the correlation between hassle frequency and mental health problems that has been previously found in a middle-class, western sample. In contrast to daily hassles, which include low-intensity, relatively discrete stressors (e.g. disagreement with spouse, missing a bus), chronic strains include ongoing social and environmental conditions that represent high-intensity stressors (e.g. substandard housing, inadequate access to water) that threaten survival. We found that chronic strains were associated with greater levels of psychosomatic symptomatology, as well as lower perceived social support. Furthermore, the correlation between chronic strains and psychosomatic symptoms increased when the effects of income were statistically controlled, suggesting that income attenuates the effects of chronic strains and that chronic strains affect symptoms independent of income. In sum, chronic strains may be a more valid and potent stressor than daily hassles in poor, urban populations in developing countries.

Developmental and gender differences in anonymous support-seeking: analysis of data from a community help line for children.

Calls to a community help line for children were analyzed for developmental and gender trends in support-seeking during middle childhood. Results indicated that between the ages of 10 and 11 the nature of help-seeking by callers changed, with a shift toward more informational support-seeking and concern regarding interpersonal problems. This shift was particularly dramatic for girls. Gender differences in the type of support sought (informational vs. instrumental) were slight. Parallels with other studies of stress and coping in children are drawn.